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A novel use of intratympanic dexamethasone for intractable posterior canal benign paroxysmal positional vertigo: report of two cases

Published online by Cambridge University Press:  29 November 2018

A Kelkar  and
I Johnson
A Kelkar*
Affiliation:
Department of ENT, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
I Johnson
Affiliation:
Department of ENT, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
*
Author for correspondence: Mr Ajinkya Kelkar, Department of ENT, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK E-mail: ajinkya@doctors.net.uk Fax: +44 (0)191 223 1246
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Abstract

Background

Benign paroxysmal positional vertigo is a common inner-ear pathology, characterised by episodic vertigo lasting for a few seconds that is associated with sudden change in the head position. Benign paroxysmal positional vertigo is treated with canalolith repositioning manoeuvres. Intractable vertigo describes a small group of patients who either do not improve with canalolith repositioning manoeuvres (persistent cases) or who relapse after improvement of initial symptoms (recurrent cases). These cases are difficult to treat and may have to be treated surgically.

Case reports

This paper reports two cases of intractable posterior canal benign paroxysmal positional vertigo that were treated with intratympanic dexamethasone injections on an interval basis.

Results

Both patients showed good control of their vertiginous symptoms, with negative Dix–Hallpike test findings following the intervention.

Conclusion

The findings support an underlying inflammatory pathology in intractable benign paroxysmal positional vertigo; intratympanic steroids should be considered as an intermediate option before proceeding to a definitive surgical intervention.

Keywords

Benign Paroxysmal Positional VertigoSteroidsDexamethasoneInjectionsMiddle Ear
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 132 , Issue 12 , December 2018 , pp. 1147 - 1149
Copyright
Copyright © JLO (1984) Limited, 2018 

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Footnotes

Mr A Kelkar takes responsibility for the integrity of the content of the paper

References

1Lynn, S, Pool, A, Rose, D, Brey, R, Suman, V. Randomized trial of the canalolith repositioning procedure. Otolaryngol Head Neck Surg 1995;113:712–20Google Scholar
2Burton, MJ, Eby, TL, Rosenfeld, RM. Extracts from the Cochrane Library: modifications of the Epley (canalith repositioning) maneuver for posterior canal benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 2012;147:407–11Google Scholar
3Fife, TD, Iverson, DJ, Lempert, T, Furman, JM, Baloh, RW, Tusa, RJ et al. Practice parameter: therapies for benign paroxysmal positional vertigo (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2008;70:2067–74Google Scholar
4Steenerson, RL, Cronin, GW, Marbach, PM. Effectiveness of treatment techniques in 923 cases of benign paroxysmal positional vertigo. Laryngoscope 2005;115:226–31Google Scholar
5Horii, A, Kitahara, T, Osaki, Y, Imai, T, Fukuda, K, Sakagami, M et al. Intractable benign paroxysmal positioning vertigo: long-term follow-up and inner ear abnormality detected by three-dimensional magnetic resonance imaging. Otol Neurotol 2010;31:250–5Google Scholar
6Pérez, P, Franco, V, Oliva, M, López Escámez, JA. A pilot study using intratympanic methylprednisolone for treatment of persistent posterior canal benign paroxysmal positional vertigo. J Int Adv Otol 2016;12:321–5Google Scholar
7Choi, SJ, Lee, JB, Lim, HJ, Park, HY, Park, K, In, SM et al. Clinical features of recurrent or persistent benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 2012;147:919–24Google Scholar
8Corvera Behar, G, García de la Cruz, MA. Surgical treatment for recurrent benign paroxysmal positional vertigo. Int Arch Otorhinolaryngol 2017;21:191–4Google Scholar
9Ahmed, RM, Pohl, DV, MacDougall, HG, Makeham, T, Halmagyi, GM. Posterior semicircular canal occlusion for intractable benign positional vertigo: outcome in 55 ears in 53 patients operated upon over 20 years. J Laryngol Otol 2012;126:677–82Google Scholar
10Shaia, WT, Zappia, JJ, Bojrab, DI, LaRouere, ML, Sargent, EW, Diaz, RC. Success of posterior semicircular canal occlusion and application of the dizziness handicap inventory. Otolaryngol Head Neck Surg 2006;134:424–30Google Scholar
11Barany, R. Diagnosing pathologies in the area of otolith apparatus [in German]. Acta Otolaryngol 1921;2:434–7Google Scholar
12Dix, MR, Hallpike, CS. The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system. Ann Otol Rhinol Laryngol 1952;61:987–1016Google Scholar
13Schuknecht, HF. Cupulolithiasis. Arch Otolaryngol 1969;90:765–78Google Scholar
14Epley, JM. New dimensions of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 1980;88:599–605Google Scholar
15Schratzenstaller, B, Wagner-Manslau, C, Alexiou, C, Arnold, W, Arnol, W. High-resolution three-dimensional magnetic resonance imaging of the vestibular labyrinth in patients with atypical and intractable benign positional vertigo. ORL J Otorhinolaryngol Relat Spec 2001;63:165–77Google Scholar
16Dallan, I, Bruschini, L, Neri, E, Nacci, A, Segnini, G, Rognini, F et al. The role of high-resolution magnetic resonance in atypical and intractable benign paroxysmal positional vertigo: our preliminary experience. ORL J Otorhinolaryngol Relat Spec 2007;69:212–17Google Scholar
17Hargunani, CA, Kempton, JB, DeGagne, JM, Trune, DR. Intratympanic injection of dexamethasone: time course of inner ear distribution and conversion to its active form. Otol Neurotol 2006;27:564–9Google Scholar
18Yang, J, Wu, H, Zhang, P, Hou, DM, Chen, J, Zhang, SG. The pharmacokinetic profiles of dexamethasone and methylprednisolone concentration in perilymph and plasma following systemic and local administration. Acta Otolaryngol 2008;128:496–504Google Scholar
19Shirway, NA, Seidman, MD, Tang, W. Effect of transtympanic injection of steroids on cochlear blood flow, auditory sensitivity, and histology in the guinea pig. Am J Otol 1988;19:230–5Google Scholar
20Slattery, WH, Fisher, LM, Iqbal, Z, Friedman, RA, Liu, N. Intratympanic steroid injection for treatment of idiopathic sudden hearing loss. Otolaryngol Head Neck Surg 2005;133:251–9Google Scholar
21Liu, YC, Chi, FH, Yang, TH, Liu, TC. Assessment of complications due to intratympanic injections. World J Otorhinolaryngol Head Neck Surg 2016;2:13–16Google Scholar